Sending daily text message reminders to health workers can mean that nearly 25% more children are properly treated for malaria, according to the results of a six month trial conducted in Kenya.
Researchers reporting their findings in The Lancet said that the technique – where text messages are sent via cell phone to urge health workers to check their patients and reminding them how to do it – would be cheap and easy to extend to a national scale, with the potential to save many lives and reduce the risk of drug resistance.
Africa accounts for around 90% of the some 800,000 malaria deaths every year, mainly among children under five. There are around 240 million cases of the mosquito-borne disease worldwide each year, according to the World Health Organization, and in Africa malaria kills a child every 45 seconds.
Adherence by health workers to malaria treatment guidelines is vital in making sure patients stick to and complete malaria treatment courses.
If patients fail to do this, or do it wrong, it can affect their recovery and also increase the likelihood of the malaria parasites developing resistance to the drugs.
But despite the relatively simple guidelines, malaria experts say failure by the health workers to adhere to the guidelines has been widely reported across Africa.
Text message analysis
Researchers enrolled 119 health workers from 107 rural health facilities across Kenya and randomly assigned them to receive text-message reminders or not.
The trial ran between March 2009 and May 2010 and text messages consisted of two components – a reminder about how to assess or manage a potential malaria case, based on Kenyan national health guidelines, and a motivational quote.
One text message said: "Check ALL sick children <5yrs for any severe signs! Also check for fever, cough, diarrhoea, pallor & any other problem. 'Persistent work triumphs.”
Another example said: "Child has FEVER when complained by mother, or child is hot, or Temp is >=37•5 - Pls ask mother, touch child & take Temp! "Actions speak louder than words.”
Interpretation of the study
The study showed a 25% improvement in health work practitioners providing the right care to patients with malaria. The texts also resulted in a substantial increase in the number of patients who got prompt anti-malarial treatment at the health facility and were correctly advised about how and when to take the remaining tablets when they were at home, the researchers said.
"This trial has shown that a simple intervention like SMS (texts) can improve health workers' adherence to malaria treatment guidelines," said Dejan Zurovac of the Kenya Medical Research Institute-Wellcome Trust Research Programme in Nairobi, who led the study.
Text messaging is increasingly being used in healthcare to promote health and help prevent disease. Like much of the developing world, mobile phone use in Kenya is widespread. The country has 22 million mobile phone subscribers, and 86% of the population has access to mobile network coverage.
The research team said the simplicity and low cost of text messaging means it could be scaled up quickly and successfully.
The cost of a text message in Kenya is about one US cent, they said, which would translate into program costs of $2.60 per health worker, or $39,000, about R1800, if used for the estimated 15,000 health workers in all rural facilities across Kenya.
(Reuters Health, Kate Kelland, August 2011)
Symptoms of malaria